ampm policy 320-t1 - azahcccs.gov€¦ · populations. this excludes federal emergency services...

AHCCCS MEDICAL POLICY MANUAL

SECTION 320 – SERVICES WITH SPECIAL CIRCUMSTANCES

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320-T1 –BLOCK GRANTS AND DISCRETIONARY GRANTS

EFFECTIVE DATES: 07/01/20 as specified in Section F, MENTAL HEALTH BLOCK GRANT,

10/01/20

APPROVAL DATES: 05/04/21 Retroactive Approval for 07/01/20 changes, 07/02/20

I. PURPOSE

This Policy applies to ACC, DCS/CMDP (CMDP), DES/DDD (DDD), ALTCS E/PD,

RBHA Contractors, and other entities who have a direct Non-Title XIX/XXI funded

contractual relationship with AHCCCS (collectively ‘Contractors’; and Fee-For-Service

(FFS) Programs including: American Indian Health Program (AIHP); TRBHAs; and all FFS

populations. This excludes Federal Emergency Services (FES). (For FES, refer to AMPM

Chapter 1100). This Policy specifies Non-Title XIX/XXI behavioral health services funded

by Block Grants and Discretionary Grants available for members and Care Coordination

requirements of all involved entities to ensure each member’s continuity of care.

II. DEFINITIONS

ALLOCATION LETTER Communication provided by AHCCCS to identify funding not

otherwise included in the "Original" Allocation Schedule and

specific terms and conditions for receipt of Non-Title XIX/XXI

funding.

ALLOCATION

SCHEDULE

The schedule prepared by AHCCCS that specifies the Non-Title

XIX/XXI non-capitated funding sources by program including

MHBG and SABG Federal Block Grant funds, discretionary grant

funds, and other funds, which are used for services not covered by

Title XIX/XXI funding and for populations not otherwise covered

by Title XIX/XXI funding.

DISCRETIONARY

GRANT

A competitive or non-competitive grant (or cooperative

agreement) for which the federal awarding agency generally may

select the recipient from among all eligible recipients, may decide

to make or not make an award based on the programmatic,

technical, or scientific content of an application, and can decide

the amount of funding to be awarded.

EARLY SERIOUS

MENTAL ILLNESS

(ESMI)

A first onset of serious mental illness which can include a first

episode of psychosis and may manifest as symptoms that include

problems in perception (such as seeing, hearing, smelling, tasting

or feeling something that is not real), thinking (such as believing

in something that is not real even when presented with facts),

mood, and social functioning.



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ELIGIBLE

POPULATIONS

Populations that within a specific grant or funding requirements

are identified as the only allowable population on which those

specific funds may be expended. Eligible populations are

identified using demographic information. Different grants or

funding sources may have varying priority populations.

EVIDENCE

BASED PRACTICES AND

PROGRAMS

(EBPPS)

An intervention that is recognized as effective in treating a

specific health-related condition based on scientific research; the

skill and judgment of health care professionals; and the unique

needs, concerns and preferences of the individual receiving

services.

FIRST

EPISODE

PSYCHOSIS (FEP)

PROGRAM

A program focused on the early identification and provision of

evidence-based treatment and support services to individuals, who

have experienced a first episode of psychosis (FEP) within the

past two years. Evidence-based FEP programs have been shown

to improve symptoms, reduce relapse, and lead to better

outcomes. A commonly used evidenced based model is

Coordinated Specialty Care, which is a recovery-based approach

that uses shared decision making and offers case management,

psychotherapy, medication management, family education and

support, and supported education or employment.

FORMULA GRANT

Allocations of federal funding to states, territories, or local units

of government determined by distribution formulas in the

authorizing legislation and regulations. To receive a formula

grant, the entity shall meet all the eligibility criteria for the

program, which are pre-determined and not open to discretionary

funding decisions.

GENERAL MENTAL

HEALTH

(GMH)

Behavioral health services provided to adult members age 18 and

older who have not been determined to have a Serious Mental

Illness and have a behavioral health diagnosis other than

substance use disorder.

HIV EARLY

INTERVENTION

SERVICES

HIV Early Intervention Services includes: appropriate pretest

counseling, testing for HIV, including tests to confirm the

presence of HIV, to diagnose the extent of the deficiency in the

immune system, and to provide information on appropriate

therapeutic measures for preventing and treating the deterioration

of the immune system, and for preventing and treating conditions

arising from the disease. Appropriate post-test counseling and

Therapeutic measures will also be provided (42 USC § 300x-

24(b)(7).



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HUMAN

IMMUNODEFICIENCY

VIRUS

(HIV)

Human immunodeficiency virus (HIV) is a Sexually Transmitted

Infection (STI) that damages white blood cells that are very

important in helping the body fight infection and disease. HIV is

also commonly transmitted through direct contact with certain

bodily fluids (e.g. sharing syringes for intravenous substance use)

such as blood, semen, rectal fluids and vaginal fluids, and breast

milk.

INTERAGENCY SERVICE

AGREEMENT

(ISA)

A contract between state government agencies whereby one

agency provides reimbursement for services performed by

another agency to carry out the objectives of the funding

source. Refer to A.R.S. § 35-148.

INTERGOVERNMENTAL

AGREEMENT

(IGA)

When authorized by legislative or other governing bodies, two or

more public agencies or public procurement units by direct

Contract or agreement may contract for services or jointly

exercise any powers common to the contracting parties and may

enter into agreements with one another for joint or cooperative

action or may form a separate legal entity, including a nonprofit

corporation to Contract for or perform some or all of the services

specified in the Contract or agreement or exercise those powers

jointly held by the contracting parties. A.R.S. Title 11, Chapter 7,

Article 3 (§ 11-952.A).

MEMBER For purposes of this Policy, an eligible individual who is enrolled

in AHCCCS, as defined in A.R.S. § 36-2931, § 36-2901, and

A.R.S. § 36-2981, referred to as Title XIX/XXI Member or

Medicaid Member. Also, an eligible individual who needs or

may be at risk of needing covered health-related services but does

not meet Federal and State requirements for Title XIX or Title

XXI eligibility, referred to as Non-Title XIX/XXI Member.

NON-TITLE

XIX/XXI FUNDING

For purposes of this Policy, fixed, non-capitated funds, from

Block Grants and Discretionary Grants which are used to fund

services to Non-Title XIX/XXI members and for medically

necessary services not covered by Title XIX or Title XXI

programs.

PRIMARY PREVENTION

Delivered prior to the onset of a condition, these services or

interventions are intended to prevent or reduce the risk of

developing a behavioral health or substance use problem.



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PRIMARY PREVENTION

EVIDENCE BASED

PRACTICES

(SUBSTANCE ABUSE

ONLY)

Interventions that fall into one or more of three categories:

1. The intervention is included in a federal registry of evidence-

based interventions, or

2. The intervention produced positive effects on the primary

targeted outcome, and these findings are reported in a peer-

reviewed journal, or

3. The intervention has documented evidence of effectiveness,

based on guidelines developed by the Center for Substance

Abuse Prevention and/or the state, tribe, or jurisdiction in

which the intervention took place. Documented evidence

should be implemented under four recommended guidelines,

all of which shall be followed. These guidelines require

interventions to be:

a. Based on a theory of change that is documented in a clear

logic or conceptual mode,

b. Similar in content and structure to interventions that

appear in federal registries of evidence-based

interventions and/or peer-reviewed journals,

c. Supported by documentation showing it has been

effectively implemented in the past, multiple times, and

in a manner attentive to scientific standards of evidence.

The intervention results should show a consistent pattern

of credible and positive effects, and

d. Reviewed and deemed appropriate by a panel of informed

prevention experts that includes qualified prevention

researchers experienced in evaluating prevention

interventions similar to those under review; local

prevention professionals; and key community leaders, as

appropriate (for example, law enforcement officials,

educators, or elders within indigenous cultures).

PRIOR PERIOD

COVERAGE

(PPC)

For Title XIX members, the period of time prior to the member’s

enrollment with a Contractor, during which a member is eligible

for covered services. The timeframe is from the effective date of

eligibility to the day a member is enrolled with a Contractor.

Refer to A.A.C. R9-22-1. If a member made eligible via the

Hospital Presumptive Eligibility (HPE) program is subsequently

determined eligible for AHCCCS via the full application process,

prior period coverage for the member will be covered by

AHCCCS Fee for Service and the member will be enrolled with

the Contractor only on a prospective basis.



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SECONDARY

PREVENTION

Aims to reduce the impact of a behavioral health or substance use

disorder that has already occurred. This is done by detecting and

treating a behavioral health or substance use disorder as soon as

possible to halt or slow its progress, encouraging personal

strategies to prevent recurrence, and implementing programs to

return people to their original health and function to prevent long-

term problems.

SERIOUS EMOTIONAL

DISTURBANCE (SED)

For the purposes of this Policy, a designation for persons from

birth until the age of 18 who currently meet or at any time during

the past year have met criteria for a mental, emotional, or

behavioral disorder – including within developmental and cultural

contexts – as specified within a recognized diagnostic

classification system (e.g. most recent editions of the Diagnostic

and Statistical Manual of Mental Disorders [DSM], the

International Statistical Classification of Diseases and Related

Health Problems [ICD])The disorder shall result in functional

impairment, as determined by a standardized measure, which

impedes progress towards recovery and substantially interferes

with or limits the individual’s role or functioning in family,

school, employment, relationships, or community activities.

Functional impairments of episodic, recurrent, and continuous

duration are included unless they are temporary and expected

responses to stressful events in the environment. This definition

is not intended to include conditions that are attributable to the

physiologic effects of a substance, substance use disorder, are

attributable to an intellectual developmental disorder, autism

spectrum disorder, or are attributable to another medical

condition, unless they co-occur with another diagnosable serious

emotional disturbance. Children who would have met functional

impairment criteria during the referenced year without the benefit

of treatment or other support services are included in this

definition.

SERIOUS

MENTAL ILLNESS

(SMI)

A designation as defined in A.R.S. § 36-550 and determined in an

individual 18 years of age or older.

SUBSTANCE USE

DISORDER (SUD)

A range of conditions that vary in severity over time, from

problematic, short-term use/abuse of substances to severe and

chronic disorders requiring long-term and sustained treatment and

recovery management.

https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems

https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems



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TERTIARY PREVENTION

Aims to soften the impact of an ongoing a behavioral health or

substance use disorder that has lasting effects. This is done by

helping people manage long-term, often-complex health problems

and injuries (e.g. chronic diseases, permanent impairments) in

order to improve as much as possible their ability to function,

their quality of life, and their life expectancy.

III. POLICY

ACC CMDP, DDD, E/PD Contractors, AIHP, and FFS Providers do not receive or

administer Non-TXIX/XXI funds. Per the Non-Title XIX/XXI Contracts/IGAs, the RBHAs

and TRBHAs are responsible for administering Non-Title XIX/XXI funds. The RBHAs,

TRBHAs, and other entities that have a direct Non-Title XIX/XXI funded contractual

relationship with AHCCCS shall manage available Non-Title XIX/XXI funds in a manner

consistent with the Non-Title XIX/XXI’s identified Eligible Populations.

Contractors, TRBHAs, Tribal ALTCS, and Fee-For-Service providers shall assist Members

in accessing services utilizing these funding sources and shall coordinate care for Members

as appropriate.

A. GENERAL REQUIREMENTS FOR CODING/BILLING

All applicable Current Procedural Terminology (CPT) and Healthcare Common

Procedure Coding System (HCPCS) for Non-Title XIX/XXI Services are listed in the

AHCCCS Behavioral Health Services Matrix (previously referred to as the B2 Matrix)

found on the AHCCCS website. Providers are required to utilize national coding

standards including the use of applicable modifier(s), as applicable. Refer to the

AHCCCS Medical Coding Resources webpage and the AHCCCS Behavioral Health

Services Matrix.

For outpatient behavioral health services, services are considered medically necessary

regardless of a Member’s diagnosis, so long as there are documented behaviors and/or

symptoms that will benefit from behavioral health services and a valid ICD-10-CM

diagnostic code is utilized.

B. NON-TITLE XIX/XXI BEHAVIORAL HEALTH SERVICES

AHCCCS covers Non-Title XIX/XXI behavioral health services (mental health and/or

substance use) within certain limits for Title XIX/XXI and Non-Title XIX/XXI Members

when medically necessary. Behavioral health services covered under the Block and

Discretionary Grants are specified below. Refer to AMPM Policy 320-T2 for services

covered under Non-Title XIX/XXI Funding (excluding Federal Grant Funds).

For information and requirements regarding Title XIX/XXI Behavioral Health Services,

refer to AMPM Policy 310-B.

All services provided shall have proper documentation maintained in the Member’s

medical records.



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For billing limitations, refer to the AHCCCS FFS Provider Manual and AHCCCS

Medical Coding Resources webpage.

1. Auricular Acupuncture Services

Auricular Acupuncture services is the application of auricular acupuncture needles to

the pinna, lobe, or auditory meatus to treat alcoholism, substance use or chemical

dependency by a certified acupuncturist practitioner pursuant to A.R.S. § 32-3922.

2. Childcare Services (also referred to as child sitting services)

Childcare supportive services are covered when providing medically necessary

Medicated Assisted Treatment or outpatient (non-residential) treatment or other

supportive services for SUD to Members with dependent children, when the family is

being treated as a whole. The following limitations apply:

a. The amount of childcare services and duration shall not exceed the duration of

(MAT) or Outpatient (non-residential) treatment or support services for SUD

being provided to the Member whose child(ren) is present with the Member at the

time of receiving services,

b. Childcare services shall ensure the safety and well-being of the child while the

Member is receiving services that prevent the child(ren) from being under the

direct care or supervision of Member,

c. The child is not an enrolled Member receiving billable services from the provider,

and

d. Other means of support for childcare for the children are not readily available or

appropriate.

3. Mental Health Services (Traditional Healing Services)

Treatment services for mental health or substance use problems provided by qualified

traditional healers. These services include the use of routine or advanced techniques

aimed to relieve the emotional distress evident by disruption of the individual’s

functional ability.

4. Supported Housing

Supported housing services are provided by behavioral health professionals,

behavioral health technicians, or behavioral health paraprofessionals, to assist

individuals or families to obtain and maintain housing in an independent community

setting including the individual’s own home or apartments and homes owned or

leased by a provider.

5. Mental Health Services, Room and Board

The provision of lodging and meals to an individual residing in a residential facility

or supported independent living setting which may include but is not limited to:

a. Housing costs,

b. Services such as food and food preparation,

c. Personal laundry, and

d. Housekeeping.

This service may also be used to report bed hold/home pass days in Behavioral

Health Residential facilities.



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For room and board services, the following billing limitations apply:

a. All other fund sources (e.g. Arizona Department of Child Safety (DCS) funds for

foster care children, SSI) shall be exhausted prior to billing this service, and

b. For Substance Abuse Block Grant (SABG) funding only, Room and Board

services may be available for a Member’s dependent child(ren) as a support

service for the Member when they are receiving medically necessary residential

treatment services for a SUD. The Room and Board would apply to a Member

with dependent children when the child(ren) reside with the Member at the

Behavioral Health Residential Facility. The use of this service is limited to:

i. Members receiving residential services for SUD treatment where the family is

being treated as a whole, but the child is not an enrolled Member receiving

billable services from the provider.

6. Other Non-Title XIX/XXI Behavioral Health Services

For Non-Title XIX/XXI eligible populations, most behavioral health services that are

covered through Title XIX/XXI funding are also covered through Non-Title XIX/XXI

funding including but not limited to: services provided in a residential setting,

counseling, case management, and supportive services, but Non-Title XIX/XXI

funded services may be restricted to certain Members as described in this Policy and

as specified in AMPM Exhibit 300-2B and are not an entitlement. Services provided

through Non-Title XIX/XXI funding are limited by the availability of funds.

C. NON-TITLE XIX/XXI ELIGIBLE POPULATIONS

Non-Title XIX/XXI eligible Members are enrolled with a RBHA or TRBHA and other

entities who have a direct Non-Title XIX/XXI funded contractual relationship with

AHCCCS, enrollment is based on the zip code or tribal community in which the Member

resides. When encounters are submitted for “unidentified” individuals (such as in crisis

situations when an individual’s eligibility or enrollment status is unknown), Contractors

shall require their providers to use the applicable pseudo-ID numbers that are assigned to

each RBHA. For assistance, contact the DHCM/Operations, Encounters Unit. Pseudo-

ID numbers are not assigned to TRBHAs. Encounters are not submitted for Prevention

services.

Crisis Services for Title XIX/XXI Members: refer to AMPM Policy 310-B for a more

detailed description of Crisis Intervention Services and responsibilities.

For Non-Title XIX/XXI eligible Members: RBHAs and TRBHAs are responsible for

Crisis Intervention services for Non-Title XIX/XXI eligible Members (up to 72 hours).

D. SUBSTANCE ABUSE BLOCK GRANT

1. Purpose and Goals

The SABG is a Formula Grant, which supports treatment services for Title XIX/XXI

and Non-Title XIX/XXI Members with SUDs and primary substance use and misuse

Prevention efforts. The SABG is used to plan, implement, and evaluate activities to

prevent and treat SUDs. Grant funds are also used to provide Early Intervention



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Services for HIV and tuberculosis disease in high-risk individuals who use

substances.

The SABG is specifically allocated to provide services that are not otherwise covered

by Title-XIX/XXI funding.

Refer to AMPM Exhibit 300-2B for additional information on SABG covered

services.

Goals of the SABG include, but are not limited to the following:

a. To ensure access to a comprehensive system of care, including employment,

housing services, case management, rehabilitation, dental services, and health

services, as well as SUD services and supports,

b. To promote and increase access to evidence-based practices for treatment to

effectively provide information and alternatives to youth and other at-risk

populations to prevent the onset of substance use or misuse,

c. To ensure specialized, gender-specific, treatment as specified by AHCCCS and

recovery support services for females who are pregnant or have dependent

children and their families in outpatient/residential treatment settings,

d. To ensure access for underserved populations, including youth, residents of rural

areas, veterans, Pregnant Women, Women with Dependent Children, People Who

Inject Drugs (PWID) and older adults,

e. To promote recovery and reduce risks of communicable diseases, and

f. To increase accountability through uniform reporting on access, quality, and

outcomes of services.

2. Eligible Populations

All Members receiving SABG-funded services are required to have a Title XIX/XXI

eligibility screening and application completed and documented in the medical record

at the time of intake and annually thereafter.

a. Members shall indicate active substance use within the previous 12-months to be

eligible for SABG treatment services. This includes individuals who were

incarcerated and reported using while incarcerated. The 12-month standard may

be waived for individuals:

i. On medically necessary methadone maintenance upon assessment for

continued necessity, and/or

ii. Incarcerated for longer than 12 months that indicate substance use in the 12

months prior to incarceration.

3. Priority Populations

SABG funds are used to ensure access to treatment and long-term supportive services

for the following populations (in order of priority):

a. Pregnant women/teenagers who use drugs by injection,

b. Pregnant women/teenagers with a SUD,

c. Other persons who use drugs by injection,

d. Women and teenagers with a SUD, with dependent children and their families,

including women who are attempting to regain custody of their children, and



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e. All other individuals with a SUD, regardless of gender or route of use, (as funding

is available).

4. Grant funding is the payor of last resort for Title XIX/XXI behavioral health covered

services which have been exhausted (e.g. respite), Non-Title XIX/XXI covered

services, and for Non-Title XIX/XXI eligible Members for any services. Grant

funding shall not be used to supplant other funding sources, if funds from the Indian

Health Services and/or Tribal owned/or operated facilities are available, the IHS/638

funds shall be treated as the payor of last resort.

5. Adolescents in Detention - Most adjudicated youth from secure detention do not have

community follow-up or supervision, therefore, risk factors remain unaddressed.

Youth in juvenile justice systems often display a variety of high-risk characteristics

that include inadequate family support, school failure, negative peer associations, and

insufficient use of community-based services. Contractors and TRBHAs requesting

to use SABG funding shall provide AHCCCS with a comprehensive and detailed plan

that includes services and activities that will be provided to adolescents in detention.

AHCCCS approval is contingent on funding availability and the Contractor’s and

TRBHA’s comprehensive and detailed plan. For adolescents in detention the

following limitations apply:

a. Services may only be provided in juvenile detention facilities meeting the

description provided by the Office of Juvenile Justice and Delinquency

Prevention (OJJDP). Although TXIX services are limited for inmates of public

institutions, for purposes of administering SABG, juvenile detention facilities are

used only for temporary and safe custody, are not punitive, and are not

correctional or penal institutions,

b. Services shall be provided:

i. Only to voluntary members,

ii. By qualified BHPs/BHTs/BHPPs,

iii. Based upon assessed need for SUD services,

iv. Utilizing EBPPs,

v. Following an individualized service plan,

vi. For a therapeutically indicated amount of duration and frequency, and

vii. With a relapse Prevention plan completed prior to discharge/transfer to a

community based provider.

6. Charitable Choice of SABG Providers - Members receiving SUD treatment services

under the SABG have the right to receive services from a provider to whose

religious character they do not object. Behavioral health providers providing SUD

treatment services under the SABG shall notify Members at the time of intake of this

right utilizing Attachment A. Providers shall document that the Member has received

notice in the Member’s medical record.

If a Member objects to the religious character of a behavioral health provider, the

provider shall refer the Member to an alternate provider within seven days, or

earlier when clinically indicated, after the date of the objection. Upon making

such a referral, providers shall notify the RBHAs or TRBHAs, of the referral and

ensure that the Member makes contact with the alternative provider. RBHAs and

TRBHAs shall develop and make available policies and procedures that indicate



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who the providers should contact and how they should notify the RBHAs or

TRBHA of these referrals. RBHAs and TRBHAs’ providers shall maintain a list

of all referrals to alternate providers regarding charitable choice requirements to

be provided to AHCCCS upon request [42 CFR Part 54 and 54a].

7. Ensure that providers promptly submit information for Priority Population Members

(i.e. Pregnant Women, Women with Dependent Children, and PWID) who are waiting

for placement in a Behavioral Health Residential Facility (BHRF), to the AHCCCS

SABG Priority Population Waitlist, or in a different format upon written approval

from AHCCCS as specified in Contract. Title XIX/XXI Members may not be added

to the AHCCCS SABG Priority Population Waitlist.

Priority Population Members who are not pregnant, parenting women, or PWID shall

be added to the AHCCCS SABG Priority Population Waitlist if the RBHAs,

TRBHAs, or their providers are not able to place the Member in a BHRF within the

Response Timeframes for Designated Behavioral Health Services as outlined in

Contract.

For women who are pregnant, the requirement is within 48 hours, for women with

dependent children the requirement is within five calendar days, and for all PWID the

requirement is within 14 calendar days.

8. HIV Early Intervention Services - Because individuals with SUDs are considered at

high risk for contracting HIV-related illness, the SABG requires HIV intervention

services in order to reduce the risk of transmission of this disease. With respect to

individuals undergoing treatment for substance use, the RBHAs/TRBHAs shall make

available to the individual HIV early intervention services pursuant to 45 CFR 96.121

at the sites in which the individuals are undergoing such treatment.

RBHAs and TRBHAs receiving SABG funding, shall develop and make available to

providers policies and procedures that describe where and how to access HIV Early

Intervention Services, noting that services are provided exclusively to populations

with SUDs. RBHAs and TRBHAs offering intervention services shall:

a. Provide early intervention services for HIV in geographic areas of the state that

have the greatest need and rural areas,

b. Require programs to establish linkages with a comprehensive community

resource network of related health and social services organizations to ensure a

wide-based knowledge of the availability of these services,

c. Ensure behavioral health providers provide specialized, evidence-based treatment

and recovery support services for all SABG populations,

d. Administer a minimum of one test per $600 in SABG HIV early intervention

services,

e. Conduct site visits to HIV early intervention services providers where the

Contractor’s HIV Coordinator, subcontracted provider staff, and supervisors are

present. Each site visit shall include the attendance at one education class, and

f. Collect SABG HIV Activity Reports from providers, training materials provided

to HIV Coordinators and HIV Early Intervention Services Providers, and other Ad

hoc reports related to HIV Prevention Issues.



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9. Considerations for providers when delivering services to SABG populations:

a. SABG treatment services shall be designed to support the long-term treatment and

substance-free recovery needs of eligible Members,

b. Providers of treatment services that include clinical care to those with a SUD shall

also be designed to have the capacity and staff expertise to utilize FDA-approved

medications for the treatment of SUD/OUD and/or have collaborative

relationships with other providers for service provision,

c. Specific requirements apply regarding preferential access to services and the

timeliness of responding to a Member’s identified needs, and

d. Providers shall submit specific data elements and record limited clinical

information. Refer to the AHCCCS DUGless Portal Guide for requirements.

10. Restrictions - Members shall not be charged a copayment for SUD treatment or

supportive services funded by the SABG. Sliding scale fees established regarding

room and board do not constitute a copayment.

E. SUBSTANCE ABUSE BLOCK GRANT PRIMARY PREVENTION

The purpose of the SABG Primary Prevention funds is to implement strategies that are

directed at individuals not identified to be in need of substance abuse treatment.


Populations at risk for developing substance abuse disorders and related behavioral

health consequences.

2. Primary prevention funding shall be used on interventions that prevent the use of

substances, or the onset of substance use disorders.

3. A comprehensive prevention program employs a variety of strategies to prevent and

reduce substance use. SAMHSA developed and approved the following strategies for

primary prevention, referred to as CSAP strategies. Services shall be tailored to

individual community or program needs and shall follow the six Center for Substance

Abuse Prevention (CSAP) strategies.

a. Information Dissemination: Provides knowledge and increases awareness of the

nature and extent of alcohol and other drug use, misuse, and addiction, as well as

their effects on individuals, families, and communities,

b. Education - Builds skills through structured learning processes. Critical life and

social skills include decision making, peer resistance, coping with stress problem

solving, interpersonal communication, and systematic and judgmental

capabilities,

c. Alternatives - Provides opportunities for target populations to participate in

activities that exclude alcohol and other drugs,

d. Problem Identification and Referral - Aims to identify individuals who have

indulged in illegal or age-inappropriate use of tobacco or alcohol, and individuals

who have indulged in the first use of illicit drugs, and seeks to refer those

individuals out to the appropriate services as needed,

e. Community-based Process - Provides ongoing networking activities and technical

assistance to community groups or agencies, and



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f. Environmental - Establishes or changes written and unwritten community

standards, codes, and attitudes.

4. Risk and Protective Factors

Prevention services should be tailored to address the specific risk and protective

factors that are present in the community. Risk factors are defined as characteristics

at the biological, psychological, family, community, or cultural level that precede and

are associated with a higher likelihood of negative outcomes. Risk and protective

factors and an individual’s character interact through six life or activity domains.

Within each domain are characteristics and conditions that can function as risk or

protective factors, thus each of these domains presents opportunities for prevention.

The six domains are as follows: Individual, Family, Peer, School, Community, and

Environment/Society.

Protective factors are defined as characteristics associated with a lower likelihood of

negative outcomes or that reduce a risk factor’s impact. Protective factors may be

seen as positive countering events. Risk and protective factors and an individual’s

character interact through six life or activity domains. Within each domain are

characteristics and conditions that can function as risk or protective factors, thus each

of these domains presents opportunities for prevention. The six domains are as

follows: Individual, Family, Peer, School, Community, and Environment/Society.

5. Evidence Based, Promising, and Innovative Practices/Interventions

Services should be implemented utilizing evidenced based practices (EBPs) as much

as possible, with promising and innovative practices used only in the event there is

not an appropriate EBP available to meet the substance abuse prevention needs within

the target population.

Evidence Based Practices/Interventions for primary prevention services are defined as

interventions that fall into one or more of three categories:

a. The intervention is included in a federal registry of evidence-based interventions,

or

b. The intervention produced positive effects on the primary targeted outcome, and

these findings are reported in a peer-reviewed journal, or

c. The intervention has documented evidence of effectiveness, based on guidelines

developed by the Center for Substance Abuse Prevention and/or the state, tribe, or

jurisdiction in which the intervention took place. Documented evidence should be

implemented under four recommended guidelines, all of which shall be followed.

These guidelines require interventions to be:

i. Based on a theory of change that is documented in a clear logic or conceptual

mode,

ii. Similar in content and structure to interventions that appear in federal

registries of evidence-based interventions and/or peer-reviewed journals,

iii. Supported by documentation showing it has been effectively implemented in

the past, multiple times, and in a manner attentive to scientific standards of

evidence. The intervention results should show a consistent pattern of

credible and positive effects, and

iv. Reviewed and deemed appropriate by a panel of informed prevention experts

that includes qualified prevention researchers experienced in evaluating



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prevention interventions similar to those under review, local prevention

professionals, and key community leaders, as appropriate (for example, law

enforcement officials, educators, or elders within indigenous cultures).

6. Promising Practices/Interventions for primary prevention services are defined as

interventions based on statistical analyses or a well-established theory of change,

shows potential for meeting the “evidence-based” or “research based” criteria, and

could include the use of a program that is evidence-based for outcomes other than the

alternative use.

7. Innovative Practices/Interventions for primary prevention services are defined as

interventions that serve a target population and have a promising approach but need

further refinement to become ready for rigorous evaluation.

8. Restrictions - Funds cannot be used to provide treatment services, general mental

health services, secondary or tertiary prevention, or suicide prevention. All funded

interventions shall have a substance use/abuse outcome.

F. MENTAL HEALTH BLOCK GRANT

The MHBG is a Formula Grant, which supports treatment services for Title XIX/XXI and

Non-Title XIX/XXI Members with SMI, SED, or FEP. The MHBG provides services

that are not otherwise covered by Title-XIX/XXI funding. This includes mental health

treatment and supportive services for Members who do not qualify for Title XIX/XXI

eligibility. MHBG funds are only to be used for allowable services identified in AMPM

Exhibit 300-2B.

1. The MHBG is allocated by SAMHSA for:

a. Providing community mental health services for adults with a serious mental

illness and children with a serious emotional disturbance,

b. Carrying out the plan submitted under section 300x–1(a) of U.S.C 42 by the State

for the fiscal year involved,

c. Evaluating programs and services carried out under the plan, and

d. Planning, administration, and educational activities related to providing services

under the plan.

2. Goals of the MHBG include, but are not limited to the following:

a. Ensuring access to a comprehensive system of care, including employment,

housing services, case management, rehabilitation, dental services, and health

services, as well as mental health services and supports,

b. Promoting participation by consumer/survivors and their families in planning and

implementing services and programs, as well as in evaluating State mental health

systems,

c. Ensuring access for underserved populations, including people who are homeless,

residents of rural areas, and older adults,

d. Promoting recovery and community integration for adults with SMI and children

with SED, and

e. Increasing accountability through uniform reporting on access, quality, and

outcomes of services.



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All Members receiving MHBG-funded services are required to have a Title XIX/XXI

eligibility screening and application completed and documented in the medical record

at the time of intake and annually thereafter.

To be eligible for services under MHBG, Members shall be determined to have an

SMI, an SED, or ESMI/FEP.

Screenings/assessments may be covered for Non-Title XIX/XXI eligible Members

when they are conducted to determine SMI or SED eligibility, for block grant funding

regardless of the assessment’s determination. Other funding sources, such as the

State General Fund appropriations for SMI shall be utilized before block grant

funding to ensure block grants are the payor of last resort. Refer to AMPM Policy

320-O for additional information on behavioral health assessments and

treatment/service planning.

For information regarding SMI Eligibility Determination, refer to AMPM Policy

320- P.

For more information regarding qualifying diagnoses, refer to the AHCCCS

Behavioral Health Diagnosis List

https://www.azahcccs.gov/PlansProviders/GuidesManualsPolicies/index.html

Excluded conditions, as noted in the 58 Federal Register 29422 (May 20, 1993), are

substance use disorders, developmental disorders, such as autism, and disorders

described by Z codes (V codes under ICD-9), unless the condition is co-occurring

with a diagnosable serious emotional disturbance.

For the purposes of this Policy, the following are diagnoses that qualify under

ESMI/FEP. These are not intended to include conditions that are attributable to the

physiologic effects of an SUD, are attributable to an intellectual/developmental

disorder, or are attributable to another medical condition:

a. Delusional Disorder,

b. Brief Psychotic Disorder,

c. Schizophreniform Disorder,

d. Schizophrenia,

e. Schizoaffective Disorder,

f. Other specified Schizophrenia Spectrum and Other Psychotic Disorder,

g. Unspecified Schizophrenia Spectrum and Other Psychotic Disorder,

h. Bipolar and Related Disorders, with psychotic features, and

i. Depressive Disorders, with psychotic features.

Members do not have to be or designated as SMI or SED to be eligible for FEP

services.

Individuals who are accessing FEP MHBG services can be GMH at the beginning, or

throughout their FEP episode of care.



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4. MHBG funding is the payor of last resort for Title XIX/XXI behavioral health

covered services which have been exhausted (e.g. respite), Non-Title XIX/XXI

covered services, and for Non-Title XIX/XXI eligible Members for any services.

Grant funding shall not be used to supplant other funding sources except that, if funds

from the Indian Health Services (IHS) and/or Tribal owned/or operated facilities are

available, the IHS/638 funds shall be treated as the payor of last resort.

5. Effective 7/1/20, MHBG Funds for Payment of Behavioral Health Drugs for

Individuals Designated with an SMI (Both Title XIX/XXI and Non-Title XIX/XXI):

a. The TRBHAs and RBHA Contractors shall utilize available MHBG Funds to

cover applicable Medicare Part D copayments and cost sharing amounts,

including payments for the Medicare Part D coverage gap, for medications to treat

behavioral health diagnoses for Title XIX/XXI and Non-Title XIX/XXI

individuals determined to have an SMI, subject to the following:

i. Coverage of cost sharing is to be used only for federal and state reimbursable

medications used to treat an SMI behavioral health diagnoses,

ii. Medicare copayments and cost sharing are covered for medications to treat an

SMI behavioral health diagnoses when dispensed by an AHCCCS-registered

provider,

iii. The payment of Medicare Part D copayments and cost sharing amounts for

medications to treat an SMI behavioral health diagnoses for individuals

determined to have an SMI, shall be provided regardless of whether or not the

provider is in the Contractor's provider network or whether or not prior

authorization has been obtained,

iv. The TRBHAs and RBHA Contractors shall not apply pharmacy benefit

utilization management edits when coordinating reimbursement for Medicare

Cost Sharing for medications to treat a SMI behavioral health diagnoses for

individuals determined to have an SMI,

v. When a request for a medication to treat an SMI behavioral health diagnoses

has been denied by the Medicare Part D plan and the denial has been upheld

through the appeals process, the Contractor shall evaluate the request and may

elect to utilize MHBG Funds, if applicable, to cover the cost of the non-

covered Medicare Part D medication to treat a SMI behavioral health

diagnosis, and,

b. The Contractor does not have the responsibility to make Medicare Part D

copayments and cost sharing payments to pharmacy providers that are not

AHCCCS registered.

6. Services - The MHBG covers community mental health treatment and support

services for eligible populations within certain limits for Title XIX/XXI and Non-

Title XIX/XXI Members when medically necessary. Refer to AMPM Exhibit 300-2B

for additional information on MHBG covered services.

Adolescents in Detention - Most adjudicated youth from secure detention do not have

community follow-up or supervision, therefore, risk factors remain unaddressed.

Youth in juvenile justice systems often display a variety of high-risk characteristics

that include inadequate family support, school failure, negative peer associations, and

insufficient use of community-based services. Contractors and TRBHAs not already

providing these services for the SED population in detention facilities requesting to



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use MHBG funding shall provide AHCCCS with a comprehensive and detailed plan

that includes services and activities that will be provided. AHCCCS approval is

contingent on funding availability and contractor’s and TRBHA’s comprehensive and

detailed plan.

Adolescents in Detention Coverage Limitations:

a. Services may only be provided in juvenile detention facilities meeting the

description provided by the OJJDP. Juvenile detention facilities are used only for

temporary and safe custody, are not punitive, and are not correctional or penal

institutions,

b. Services shall be provided:

i. Only to voluntary members,

ii. By qualified BHPs/BHTs/BHPPs,

iii. Based upon assessed need for SED services,

iv. Utilizing EBPPs,

v. Following an individualized service plan,

vi. For a therapeutically indicated amount of duration and frequency, and

vii. With a transition plan completed prior to transfer to a community based

provider, and

7. Non-Encounterable MHBG Activities or Positions - MHBG SED services for

outreach activities or positions that are non-encounterable can be an allowable

expense, but they shall be tracked, activities monitored, and outcomes collected on

how the outreach is getting access to care for those Members with SED.

Furthermore, the use of MHBG SED funds in schools is allowable as long as the

following requirements are met:

a. Funded positions or interventions cannot be used to fulfill the requirement for the

same populations as the funds for Behavioral Health Services for School-Aged

Children listed in the Title XIX/XXI Contract,

b. Funded positions cannot bill for services provided,

c. Funded positions or interventions need to focus on identifying those with SED

and getting those who do not qualify for Title XIX/XXI engaged in services

through the MHBG, and

d. This funding shall be utilized for intervention, not Prevention, meaning that

Members who are displaying behaviors that could be signs of SED can be

assisted, but MHBG funding shall not be used for general Prevention efforts to

children who are not showing any risks of having SED.

Restrictions Members shall not be charged a copayment for mental health treatment

or supportive services funded by the MHBG. Sliding scale fees established regarding

room and board do not constitute a copayment.

G. PROJECT FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS

Project for Assistance in Transition from Homelessness (PATH) is designed to be an

outcome driven grant program to support service delivery to individuals with a Serious

Mental Illness (SMI), co-occurring SMI and substance use disorders, persons

experiencing homelessness or at imminent risk of homelessness via street outreach and to

engage individuals not currently connected to mainstream mental health services, primary



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health care and substance use service systems. PATH is a formula-based grant program

where funds are used to provide a menu of allowable services, including street outreach,

case management, and services not supported by mainstream mental health programs.


a. Adults (persons 18 years of age or older) who request or consent to a SMI

Eligibility Determination, and

b. Adults suffering from SMI and/or have co-occurring substance use disorder, or

c. Adults and families with children who are homeless, or at imminent risk of

homelessness.

H. EMERGENCY GRANTS TO ADDRESS MENTAL AND SUBSTANCE USE DISORDERS DURING

COVID-19 (EMERGENCY COVID-19)

The purpose of this program is to provide crisis intervention services, mental and

substance use disorder treatment, and other related recovery supports for children and

adults impacted by the COVID-19 pandemic. Funding will be provided for states,

territories, and tribes to develop comprehensive systems to address these needs. The

purpose of this program is specifically to address the needs of individuals with Serious

Mental Illness. Additionally, the program will also focus on meeting the needs of

individuals with mental disorders that are less severe than serious mental illness,

including those in the healthcare profession.


a. Individuals diagnosed with an SMI,

b. Individuals diagnosed with SUD,

c. Individuals with a co-occurring (SMI/SUD), and

d. Individuals with mental disorders that are less severe than SMI.

2. Contractors shall use grant funds primarily to provide direct services. Direct service

provision shall be implemented as follows:

a. 70 percent of direct service funding shall be used to provide direct services to one

of the following: those with serious mental illness, those with SUDs, or those with

co-occurring SMI and SUDs,

b. Ten percent of direct service funding shall be used for healthcare practitioners

with mental disorders (less severe than SMI) requiring mental health care as a

result of COVID-19, and

c. Twenty percent of direct service funding shall be used for all other individuals

with mental disorders less severe than SMI. Contractor(s) shall clearly specify

which population(s) will be served.

3. Contractors shall utilize third party reimbursements and other revenue realized from

the provision of services to the extent possible and use SAMHSA grant funds only for

services to individuals who are not covered by public or commercial health insurance

programs, individuals for whom coverage has been formally determined to be

unaffordable, or for services that are not sufficiently covered by an individual’s health

insurance plan.



320-T1 - of 24

4. Contractors shall facilitate the health insurance application and enrollment process for

eligible uninsured clients.

5. Contractors shall also consider other systems from which a potential member may be

eligible for services (e.g. the Veterans Health Administration or senior services), if

appropriate for, and desired by, that individual to meet his/her needs.

6. Contractors shall implement policies and procedures that ensure other sources of

funding are utilized before Emergency COVID-19 Grants funds are used when other

funding sources are available for that individual.

7. Services - Contractor(s) shall provide the following services as stated in their contract

with AHCCCS and approved budget:

a. Develop and implement a comprehensive plan of evidence-based mental and/or

substance use disorder treatment services for individuals impacted by the COVID-

19 pandemic. Ensure that service provision may occur in a telehealth context

including the use of telephone,

b. Screen and assess clients for the presence of mental and substance use disorders

and/or co-occurring disorders, and use the information obtained from the

screening and assessment to develop appropriate treatment approaches,

c. Provide evidence-based and population appropriate treatment services,

i. Provide recovery support services (e.g. linkages to nutrition/food services,

individual support services, childcare, vocational, educational, linkages to

housing services, and transportation services) which will improve access to,

and retention in services. Contractors shall ensure the ability to provide these

services virtually where needed, and

ii. Develop and implement Crisis mental health services.

8. Restrictions Emergency COVID-19 Grants funds shall not be used to:

a. Directly or indirectly, purchase, prescribe, or provide marijuana or treatment

using marijuana. Treatment in this context includes the treatment of opioid use

disorder. Grant funds also cannot be provided to any individual who or

organization that provides or permits marijuana use for the purposes of treating

substance use or mental disorders. Refer to 45 CFR 75.300(a) (requiring HHS to

“ensure that Federal funding is expended in full accordance with U.S. statutory

requirements.”), 21 U.S.C. §§ 812(c)(10) and 841 (prohibiting the possession,

manufacture, sale, purchase or distribution of marijuana). This prohibition does

not apply to those providing such treatment in the context of clinical research

permitted by the DEA and under an FDA-approved investigational new drug

application where the article being evaluated is marijuana or a constituent thereof

that is otherwise a banned controlled substance under federal law,

b. Pay for promotional items including, but not limited to, clothing and

commemorative items such as pens, mugs/cups, folders/folios, lanyards, and

conference bags,

c. Pay for the purchase or construction of any building or structure to house any part

of the program,

d. Provide residential or outpatient treatment services when the facility has not yet

been acquired, sited, approved, and met all requirements for human habitation and

services provision,



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e. Provide inpatient treatment or hospital-based detoxification services. Residential

services are not considered to be inpatient or hospital-based services,

f. Make direct payments to individuals to enter treatment or continue to participate

in prevention or treatment services,

g. Provide meals unless they are an integral part of a conference grant or specifically

stated as an allowable expense. Grant funds may be used for light snacks, not to

exceed $3.00 per individual per day,

h. Purchase sterile needles or syringes for the hypodermic injection of any illegal

drug. Provided, That such limitation does not apply to the use of funds for

elements of a program other than making such purchases if the relevant State or

local health department, in consultation with the Centers for Disease Control and

Prevention, determines that the State or local jurisdiction, as applicable, is

experiencing, or is at risk for, a significant increase in hepatitis infections or an

HIV outbreak due to injection drug use, and such program is operating in

accordance with state and local law.

i. Purchase of personal protective equipment (PPE) except for use by staff charged

to the grant. Purchase of PPE for other employees or clients is not an allowable

use of these funds, or

j. Purchase equipment or supplies (e.g. pre-paid minutes, cell phones, hot spots,

iPad, tablets) for clients.

I. STATE OPIOID RESPONSE GRANT

The SOR program aims to address the opioid crisis by increasing access to medication-

assisted treatment using the three FDA-approved medications including: methadone,

buprenorphine products, including single-entity buprenorphine products,

buprenorphine/naloxone tablets, films, buccal preparations, long-acting injectable

buprenorphine products, buprenorphine implants, and injectable extended-release

naltrexone for the treatment of Opioid Use Disorder (OUD). As well as reducing unmet

treatment need and reducing opioid overdose related deaths through the provision of

prevention, treatment, and recovery activities for OUD (including illicit use of

prescription opioids, heroin, and fentanyl and fentanyl analogs). This program also

supports evidence-based prevention, treatment, and recovery support services to address

stimulant misuse and use disorders, including for cocaine and methamphetamine.


Individuals with OUD, stimulant use disorder, and populations at risk for developing

either and related behavioral health consequences.

2. Contractors shall implement evidence-based treatments, practices, and interventions

for OUD and make available FDA-approved MAT to those diagnosed with OUD.

3. Contractors shall implement FDA-approved MAT for OUD.

Medical withdrawal (detoxification) is not the standard of care for OUD, is associated

with a very high relapse rate, and significantly increases an individual’s risk for

opioid overdose and death if opioid use is resumed. Therefore, medical withdrawal

(detoxification) when done in isolation is not an evidence-based practice for OUD. If

medical withdrawal (detoxification) is performed, it shall be accompanied by



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injectable extended-release naltrexone to protect such individuals from opioid

overdose in relapse and improve treatment outcomes.

Contractors shall employ effective prevention and recovery support services to ensure

that individuals are receiving a comprehensive array of services across the spectrum

of prevention, treatment, and recovery.

Contractors shall implement evidence-based prevention, treatment, and recovery

support services to address stimulant misuse and use disorders.

4. Services - The Contractor shall offer a comprehensive array of services across the

spectrum of prevention, treatment, and recovery for opioid use disorder and stimulant

use disorder that should be tailored to individual community or program needs.

J. NON-TITLE XIX/XXI FUNDED CARE COORDINATION REQUIREMENTS

Providers shall make it a priority to work with the RBHA and/or TRBHA to enroll the

individual in Non-Title XIX/XXI funded services immediately, while continuing to assist

the individual with the processes to determine Title XIX/XXI eligibility. If the individual

is deemed eligible for Title XIX/XXI funding, the Member can choose a Contractor and

American Indian Members may choose either a Contractor, or AIHP, or a TRBHA if one

is available in their area and receive covered services through that Contractor or AIHP or

a TRBHA. The provider shall work with the Care Coordination teams of all involved

Contractors or payers to ensure each Member’s continuity of care. Members designated

as SMI are enrolled with a RBHA. American Indian Members designated as SMI have

the choice to enroll with a TRBHA for their behavioral health assignment if one is

available in their area.

If a Title XIX/XXI Member loses Title XIX/XXI eligibility while receiving behavioral

health services, the provider shall attempt to prevent an interruption in services. The

provider shall work with the care coordinators of the Contractor or RBHA in the GSA

where the Member is receiving services, or Contractor enrolled or AIHP enrolled

Members, or the assigned TRBHA, to determine whether the Member is eligible to

continue services through available Non-Title XIX/XXI funding. If the provider does not

receive Non-Title XIX/XXI funding, the provider and Member shall work, together to

determine where the Member can receive services from a provider that does receive Non-

Title XIX/XXI funding. The provider shall then facilitate a transfer of the Member to the

identified provider and work with the Care Coordination teams of all involved

Contractors or payors. Contract language and measures stipulate that providers will be

paid for treating Members while payment details between entities are determined. If a

Title XIX/XXI Member, whether Contractor or AIHP enrolled, requires Non-Title

XIX/XXI services, the provider shall work with the RBHA in the GSA where the

Member is receiving services, or the assigned TRBHA, to coordinate the Non-Title

XIX/XXI services.

Behavioral health providers are required to assist individuals with applying for Arizona

Public Programs (Title XIX/XXI, Medicare Savings Programs, Nutrition Assistance, and

Cash Assistance), and Medicare Prescription Drug Program (Medicare Part D), including

the Medicare Part D “Extra Help with Medicare Prescription Drug Plan Costs” low



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income subsidy program prior to receiving Non-Title XIX/XXI covered behavioral health

services, at the time of intake for behavioral health services.

An individual who is found not eligible for Title XIX/XXI covered services may still be

eligible for Non-Title XIX/XXI services. An individual may also be covered under

another health insurance plan, including Medicare.

Individuals who refuse to participate in the AHCCCS screening/application process are

ineligible for state funded behavioral health services. Refer to A.R.S. §36-3408 and

AMPM Policy 650. The following conditions do not constitute an individual’s refusal to

participate:

1. An individual’s inability to obtain documentation required for the eligibility

determination, and/or

2. An individual is incapable of participating as a result of their mental illness and does

not have a legal guardian.

Pursuant to the U.S. Attorney General’s Order No. 2049–96 (61 Federal Register 45985,

August 30, 1996), individuals presenting for and receiving crisis, mental health or SUD

treatment services are not required to verify U.S. citizenship/lawful presence prior to or

in order to receive crisis services.

Members can be served through Non-Title XIX funding while awaiting a determination

of Title XIX/XXI eligibility. However, upon Title XIX eligibility determination the

covered services billed to Non-Title XIX, that are Title XIX covered, shall be reversed by

the Contractor and charged to Title XIX funding for the retro covered dates of Title XIX

eligibility. This does not apply to Title XXI Members, as there is no PPC for these

Members.

The RBHAs, TRBHAs, and other entities who have a direct Non-Title XIX/XXI funded

contractual relationship with AHCCCS are responsible for managing and prioritizing

Non-Title XIX/XXI funds to ensure, within the limitation of available funding, that

services are available for all individuals, prioritizing those with the highest level of need

and Eligible Members.

RBHAs, TRBHAs, and other entities who have a direct contractual relationship with

AHCCCS are responsible for managing Non-TXIX/XXI funding to ensure that funding is

available for the fiscal period and if all Non-Title XIX/XXI funding is expended,

RBHAs, TRBHAs, and other entities who have a direct Non-Title XIX/XXI funded

contractual relationship with AHCCCS shall provide coordination services to address the

needs through other community-based options and shall maintain a database of Members

referred for services that are unable to receive the service due to funding depletion and

shall maintain a database of Members referred for services that are unable to receive the

service due to funding. Members pending services due to funding depletion shall receive

follow up to provide alternative services as possible and available until the referred

service can be provided.



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In addition, Contractors are responsible for ensuring a comprehensive system of care for

Non-Title XIX/XXI eligible Members, and Members shifting in and out of Title

XIX/XXI eligibility. Refer to policy AMPM Policy 100 for information on the Nine

Guiding Principles for the Adult System of Care, and on the Twelve Guiding Principles

for the Children’s System of Care. System development efforts, programs, service

provision, and stakeholder collaboration shall be guided by the principles therein.

If there are any barriers to care, the provider shall work with the Care Coordination teams

of all involved health plans or payers. If the provider is unable to resolve the issues in a

timely manner to ensure the health and safety of the Member, the provider shall contact

AHCCCS/DHCM, Clinical Resolutions Unit (CRU). If the provider believes that there

are systemic problems, rather than an isolated concern, the provider shall notify

AHCCCS/DHCM, CRU of the potential barrier. AHCCCS will conduct research and

work with the Contractors and responsible entities to address or remove the potential

barriers.

K. NON-TITLE XIX/XXI FUNDING SOURCES

All Non-Title XIX/XXI funding shall be used for medically necessary behavioral health

services only.

RBHAs, TRBHAs, and other entities who have a direct Non-Title XIX/XXI funded

contractual relationship shall report each Non-Title XIX/XXI funding source and services

separately and provide information related to Non-Title XIX/XXI expenditures to

AHCCCS upon request and/or in accordance with AHCCCS Contract/ISA/IGA or as

specified in the Allocation Schedule and/or Allocation Letter.

Services provided under Non-Title XIX/XXI funds are to be encounterable. Outreach

activities or positions that are non-encounterable can be allowable expenses, but they

shall be pre-approved by AHCCCS, tracked, activities monitored, and outcomes collected

on how the activities or funded positions are facilitating access to care for Non-Title

XIX/XXI eligible populations, as specified in the Non-TXIX/XXI Contract.

Additionally, positions funded exclusively through the Non-Title XIX/XXI funding shall

not bill for services to receive additional funding from any fund source. Positions

partially funded through the Non-Title XIX/XXI funding may only bill for services

during periods when they are not being paid with Non-Title XIX/XXI funds.

Discretionary Grants - This funding can be used for purposes set forth in the various

Federal grant requirements and as defined in the terms and conditions of the Allocation

Schedules or AHCCCS Contract/IGA/ISA and/or Allocation Letters. An example of a

discretionary grant includes, but is not limited to, the State Opioid Response (SOR) grant.

L. SABG AND MHBG REPORTING REQUIREMENTS

Deliverable requirements regarding material changes to Contractor’s Non-Title XIX/XXI

provider network are identified in Non-Title XIX/XXI Contracts. For Templates and

requirements regarding the submission of a notification indicating material change to

provider network, refer to ACOM Policy 439.



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1. Deliverable Templates

For reporting requirements related to SABG and MHBG, RBHAs shall utilize the

following templates for the corresponding deliverable submissions identified in

each applicable Contract or IGA/ISA. Applicable deliverables shall be submitted

as specified in Contract or IGA/ISA.

a. Attachment A – Charitable Choice – Anti-Discrimination Notice to Individuals

Receiving Substance Use Services,

b. Attachment B – SED Program Status Report – MHBG SED Grant (for MHBG),

c. Attachment C – First Episode Psychosis Program Status Report (Annually)

(for MHBG),

d. Attachment C-1 – First Episode Psychosis Program Status Report (Quarterly)

(for MHBG),

e. Attachment D – ICR Peer Review Data Pull,

f. Attachment E – SABG HIV Activity Report,

g. Attachment F – SABG HIV Site Visit Report,

h. Attachment F-1 – Oxford House Financial Report,

i. Attachment G – SABG Agreements Report,

j. Attachment H – Oxford House Model Report,

k. Attachment I – SABG Priority Population Waitlist Report,

l. Attachment J – SABG Capacity Management Report, and

m. Attachment K – SABG/Prevention/MHBG Plan (for MHBG and SABG).

2. Block Grant Report and Plan

Reporting timeframes for the Block Grant Report and Block Grant Plan are identified

in each applicable Contract or ISA/IGA. Templates and other reporting requirements

for these deliverables are mandated by SAMHSA and are subject to change. As such,

templates for the Block Grant Report and Block Grant Plan will be provided by prior

to due dates.

ampm policy 320-t1 - azahcccs.gov€¦ · populations. this excludes federal emergency services...

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